The Brigham and Women's Hospital Inpatient Clinical Nutrition Service provides nutritional care and education to all patients and families admitted to the Brigham.
At BWH, the registered dietitians (RD) work in teams. The patient care load is divided into 4 teams. The teams are lead by Team Leader Dietitians, who are Certified Nutrition Support Dietitians (CNSD). The CNSD is especially trained in the assessment and care of the forced fed, metabolically compromised patient. Our nutrition care is integrated with the Metabolic SupportService (MSS) to ensure expert nutritional interventions for the most complex nutritional deficiencies. TheTeam Leader Dietitian and the MSS physicians meet 3 times per week to consult on new patients andreview nutrition plans on current parenterally fed patients. An integrated note signed by both the MSSphysician and the Team Leader Dietitian is documented in the medical record. The MSS and Team LeaderDietitian have the responsibility of approving or disapproving all new parenteral nutrition orders and anynew order for anabolic steroids. If an order is not approved, the MSS physician or dietitian notifies theordering physician, explaining the reason for non-approval, and offers alternative recommendations.
Daily monitoring of enteral and parenteral feedings is completed by the dietitian to ensure adequacy ofintake and to make additional recommendations for advancement or modification of the feeding. Thedietitians calculate and record all information pertaining to parenteral, enteral and oral intake in themedical record. The dietitians document on-line in a note that has been specially designed for their useonly. The note details objective criteria, classification of malnutrition, and assessment/recommendationsfor medical nutrition therapy.
The dietitians attend work rounds with the house staff. They are assigned patients by physician team orservice line to ensure effective communication and continuity of patient care throughout the patient'shospitalization.
Patients admitted to the hospital are screened for nutritional risk as part of the Nursing assessment. Once a patient is identified by the nurse, the dietitian assesses the patient and determines the level of risk and complexity of assessment, including: age; diagnosis/procedure or treatment; NPO/enteral status;metabolic/mechanical problems; height/weight changes; and laboratory values. A formal physician referralis not required for nutrition assessment.
Patients are educated on their modified diet prior to discharge. The dietitians educate patients andfamilies in individualized sessions. For cardiac surgery patients, the dietitian teaches patients and familiesin group education classes.The RDs are actively involved in the discharge process of the patients. Any patient being discharged tohome or a facility on enteral or parenteral feedings is educated by the dietitian prior to discharge. The RDcompletes a "Discharge Nutrition Care Plan," which is distributed to the primary care MD and home carecompany.
We also staff our Neonatal Intensive Care Unit (NICU) with 1.5 FTE dietitians. They are responsible for the screening, assessment, daily monitoring and nutritional discharge plan for all infants in the NICU.
The dietitians participate in many nutrition related rounds and conferences. Each week the RD's and dietetic interns assigned to clinical rotations attend MSS patient care rounds for 1 hour. During this time the dietitians present challenging and interesting cases to the director of MSS for discussion and further recommendations. Bimonthly the RD's attend Teaching Rounds which include outside speakers who present different aspects of nutritional management. Monthly, the dietitians attend Longwood Medical Rounds. These rounds are organized by Harvard Medical School and the Nutrition Departments of the hospitals in the Longwood Medical Area (Brigham and Women's, Children's Hospital, and Beth Israel-Deaconess Medical Center). National and local experts in nutrition present their latest research or clinical expertise to the RD's at Longwood Rounds.
Director of Nutrition: Kathy McManus, MS, RD
To contact our department:
Kathy McManus, MS, RD, LDN
Director, Department of Nutrition
Brigham and Women's Hospital
75 Francis Street
Boston, MA 02115
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